Challenging preconceived notions

by Everett Warren, UNC School of Medicine, Class of 2016

I wonder how often it has been said that life is precious. So often we are inundated with this idea. Life is fleeting, not guaranteed, short. What I have come to understand through my experiences with both palliative care and hospice is that what lies on the other side of life is just as precious. That is, death itself is precious. In some regards the process of dying demands more respect, honesty, and bravery than that of living. The amount of audacity it takes for an individual to accept their inevitable fate, decide that comfort is more important than treatment, and approach their last breath with peace is quite possibly the most admirable and beautiful human act I have had the privilege of witnessing. I do not believe I fully understood this concept prior to my palliative care and hospice experiences, and honestly, I believe this is largely because I was intimidated by the idea of death and having conversations about death, especially the idea of having a conversation about an individual’s death with that individual.

Our society discourages us from thinking about death. From a very young age we are bombarded with the idea that death is morbid, dark, and off-limits. This institutionalized mindset that death is taboo is hard to overcome, something I think I found personally challenging about this experience. I realized that a patient is only going to be as comfortable in discussing their death as you are comfortable in discussing it with him or her. While spending time with Hospice & Palliative Care Charlotte Region clinicians, I had the privilege of witnessing what I thought would be impossible conversations conducted multiple times with a wide variety of patients from all walks of life. Each time, I was taken aback at how comfortable not only the physician or nurse was at leading this conversation, but also at how well the patient responded. Yes, there were definitely patients and family members that were tearful and clearly upset. Yes, there were moments when the patient would verbalize how unfair the situation was or how angry they were at the circumstances. Yes, there were moments where it seemed like there was no right way to answer the questions the patient and their family were asking. However, what was most apparent was that the patient, the patient’s family, and the hospice or palliative care physician were working together as one team with the same goals. It was truly inspiring to see a physician take on a patient’s situation as their own in such a sincere and empathetic way while being so available for the patient. I truly saw empathy go beyond what I thought possible during these two short days. I aspire to live out empathy as a medical student, resident, and physician in the ways in which I saw it manifested during these two days.

Prior to this experience, I can ashamedly say that I really had no clue what exactly hospice or palliative care did, or that they were such different entities. I had the ignorant misconception that as someone begins to deteriorate and the future is looking grim then that individual should be managed by hospice or palliative care, which basically took care of the patient until they died. I did not truly understand how important the symptom management or goals of care conversations led by the palliative team were to individuals that were younger or had little chance of dying from their condition. I had no idea that individuals could graduate from palliative care and go back to living the normal lives they led before they needed the services offered by palliative care. I didn’t realize that individuals can only be placed under hospice when they only have six months to live based on the natural history of their disease state, and I definitely did not know that even if the individual lives beyond that six-month period, they may remain under the care of hospice by being re-certified.

Attending the interdisciplinary hospice meeting was truly an eye-opening experience. To see a patient’s care be viewed and planned through so many different lenses and so many different facets challenged all preconceived notions I had that hospice was just some healthcare worker feeding a patient pain medication as they slowly died. They truly identified the patient’s needs from all angles and offered them an extensive amount of services that I did not even know existed prior to attending the meeting.

Overall, I thought this was an incredible experience. I would highly recommend it for future students. It definitely impacted me in ways that I will take with me as a future physician, and I am incredibly grateful to the nurses, social workers, physicians, and most importantly the patients, for allowing me to glimpse the incredible entities that are hospice care and palliative care.